What We Can Learn About Modern Medicine From The Knick

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What We Can Learn About Modern Medicine From The Knick

Mary Cybulski/Cinemax

If Clive Owen and Steven Soderbergh aren't enough of a reason to get you watching The Knick—hey, talented directors and charismatic actors aren't everyone's jam—the rich detail with which the show portrays the evolution of medicine should be. The Knick provides an unflinching look at how crude a practice medicine was a century ago—and a glimpse at how healthcare became what it is today.

The Knick is set in New York City in 1900, when medical discoveries were occurring faster than ever before. It tells the story of the birth of modern surgery, of course, but it also chronicles the beginning of the public health system in America. Today, that system is all that stands between us and a major epidemic like, say, Ebola. And while Dr. John Thackery (Owen) is fictional, much of the medicine he practices isn't. Here's what watching an hour of Cinemax each week can teach us about modern healthcare.

Body-Snatching for Science Is a Thing

Screengrab/WIRED

The ashes Herman Barrow (Jeremy Bobb) sells Mrs. Zygmund (Maja Wampuszyc) in the scene above from "Where Is the Dignity?" are those of a pig, not her dearly departed husband. Unbeknownst to her, his body is to be used to practice surgery. Barrow, it turns out, has little dignity: He stole the body from the morgue for his doctor because he can't pay for a proper cadaver.

As we learn later in the season, cadaver fees aren't cheap. Thanks to the cunning of middlemen—morticians, ambulance drivers, etc.—the corpses were offered to the highest bidder, and even the bodies of the most indigent are expensive. When Barrow can't afford the fees, he resorts to taking bodies—and giving pig ashes to poor widows.

courtesy Cinemax

But the body business has always been tricky. During the 1600s, medical students prowled graveyards, hoping for a chance to unearth a fresh a cadaver. During *The Knick'*s early 20th century, middlemen managed the trade. As recently as 2009, the director of a cadaver laboratory at UCLA's medical school was convicted of selling donated body parts to research facilities without the school's permission.

And sometimes medical practitioners can't access body parts at all. When Barrow can't locate a cadaver, he has Dr. Thackery practice on pigs. Pigs, which have considerably human-like flesh, remain a common canvas for practicing surgeons. (And, as anyone who's taken high school biology also can tell you, for learning anatomy.)

Tuberculosis Spawned Tenement Reform in America

Screengrab: WIRED

As we see in that first episode of The Knick, doctors in the early 1900s already had determined tuberculosis was spread through the air and traveled more easily in cramped, stuffy living environments. That was how most people in New York City lived at the time, so the authorities had to step in. "No windows, no ventilation, no sunlight inside, no running water—a breeding ground for disease. That's why the new laws were passed," inspector Jacob Speight (David Fierro) tells a landlord. "I can compel you to make any and all structural changes I deem necessary to protect the public."

When Speight makes this observation he's trying to get a bribe, but the laws he's referencing are legit. In 1901, the Tenement House Act required improved living conditions for impoverished renters. This wasn't done out of altruism—that would be crazy!—but to curb the growing tuberculosis problem. For the most part, it worked. Before these legislative changes, the Centers for Disease Control and Prevention estimates 194 out of every 100,000 people in America died of TB. By the time they were widely adopted in 1940, it was down to 46 out of every 100,000.

Tracking Epidemics Is What American Health Officials Have Always Done

"Typhoid Mary" in court on The Knick.

Screengrab: WIRED

Last week, in response to a patient contracting Ebola in the US, CDC director Dr. Tom Frieden said, "We have a team on route to Texas now. They will work hand in hand with state and local and hospital public health and staff to identify all possible contacts and then monitor them every day for 21 days to see if they have fever. This is core public health work. This is what we do in public health."

Such core public health work has been happening for decades. When rich families in the upscale neighborhoods of upper Manhattan start coming down with Typhoid fever on The Knick, the city health inspector begins investigating how it is getting into those homes. Typhoid is caught from exposure to diseased feces, and these homes had modern plumbing that should have protected them from risk. What he and the lovely Cornelia Robertson (Juliet Rylance) discover is a cook named Mary Mallon, who had worked in every home hit by Typhoid.

This is, of course, a true story. In 1908, the New York City Health Inspector determined Mallon had infected 53 people with Typhoid. She carried and transmitted the disease through her food, but she herself never showed any signs of sickness. It was the first documented case of someone immune to the symptoms of a disease being a carrier. It was a groundbreaking discovery.

The ancillary lesson of the "Typhoid Mary" story is even in its earliest form in America, medicine has been plagued by class bias and injustice. As with the modern-day case of Ebola, it wasn't until Typhoid effected the wealthy that the government took meaningful action. The same rebuke has been lobbied against the World Health Organization, which has allowed incredibly rare supplies of the Ebola drug ZMapp to be given mainly to American citizens, despite the fact that the majority of Ebola victims are African.

Typhoid Mary is also a cautionary tale. As we see at the end of *The Knick'*s eighth episode, "Working Late a Lot," Mallon was released from quarantine once—the science of an asymptomatic carrier was so new that the law did not believe it. When the real-life Mallon went back to work as a laundress, she infected many more people and eventually was tracked down and quarantined until her death in 1938.